The High Court has rejected a man’s negligence claim over three operations on his left hand, finding that he had not proved that the surgeon or the North Eastern Health Board failed to provide the ordinary skill and care expected of a general surgeon working in a county hospital.
Mr Justice Charleton delivered the judgment on 23 April 2009. The plaintiff claimed that treatment for Dupuytren’s contracture left his hand practically useless for mechanical work. The claim concerned operations in June and July 1996 and April 1999. He alleged that the first operation was improperly performed and that an amputation of his little finger would have been unnecessary. He also initially complained about the 1999 operation on his ring finger, but abandoned that part of the claim during the trial.
The court assessed the surgeon against the standard of a careful and competent general surgeon who undertook hand surgery from time to time, rather than that of a specialist hand surgeon. It found that the plaintiff had a significant contracture before the first operation and that the finger was bent into his palm. The judge accepted that the joint was frozen and that amputation could be considered in those circumstances.
The judge found that the first operation involved sufficient exploration and removal of fibrous tissue, and that the decision to amputate was not caused by negligent cutting of nerves or tendons. He also found that the amputation was warranted and carefully performed. On the third operation, the court accepted that the assessment and result were good, and that the surgeon’s choice of incisions was reasonable.
The judgment considered the plaintiff’s specialist witness’s criticisms, including the alleged lack of a tourniquet and insufficient tissue removal. The court found that a tourniquet was used in the first and third operations; it was not needed for the amputation. It also accepted the surgeon’s evidence that specialist physiotherapy and the described splinting were not available to her.
The court concluded that the plaintiff had not proved negligence on the balance of probabilities. The judge added that he was not persuaded the plaintiff would probably have had a better result if referred to a specialist hand surgeon. The judgment therefore dismissed the negligence claim; it did not make a finding that specialist referral would have made no difference in every case.